The present invention relates to closing a wound, in particular a cutaneous wound.
Suturing the skin by commonly-used techniques employing thread or clips, is a relatively lengthy and tiresome task, and it involves non-negligible risks of scarring, in particular the risk that a hypertrophic scar might form.
There has long been a need to find means for closing wounds rapidly without using foreign bodies such as threads or clips, while obtaining scars that are strong and of identical or even better quality.
Bonding skin together by laser has been proposed as an alternative to suturing with thread or clips.
Unfortunately, it has been found that wounds closed using such bonding have very low traction strength during the first few days of the healing process, so that they are likely to re-open.
Attempts have been made to remedy that drawback by performing the laser irradiation in the presence of a dye chosen to increase the amount of radiation absorbed by the tissue in which the wound is situated.
Unfortunately, the use of such a dye raises difficulties associated with the quantity of dye deposited and with the reproducibility of deposition.
Proposals have also been made to use adhesives based on fibrin or on proteins, in particular human albumin serum, those adhesives being intended to impart greater strength to the closure.
Unfortunately, adding exogenous substances of human origin or of animal origin raises problems of tolerance and involves the risk of transmitting viral or spongiform diseases.
An object of the present invention is to provide apparatus for uniting the lips of a wound, which apparatus offers an alternative to suturing tissue by commonly-used techniques employing thread or clips, without suffering from the drawbacks associated with adding an exogenous substance or a foreign body.
The apparatus of the invention comprises a laser having an emission wavelength chosen such that it can perform tissue bonding and unite the lips of a wound, and a holding piece suitable for being secured to the tissue around the wound so as to keep the lips of the wound approximated, at least while the wound is being exposed to said laser radiation, the holding piece including at least one region suitable for being positioned over the wound and sufficiently transparent at the wavelength of the laser radiation for the energy from said radiation to be sufficient, after it has passed through said region, to perform the desired tissue bonding.
By means of the invention, the wound is closed well because the holding piece prevents any disuniting of the lips during the healing process.
In particular, the apparatus of the invention makes it possible to ensure that the lips are held together properly approximated during the laser irradiation.
By means of the invention, the healing takes place correctly and rapidly.
In addition, the invention makes it possible to reduce the time required for the surgeon to close the wound, compared with conventional suturing using thread.
In a particular embodiment, the holding piece is flexible, and is preferably in the form of an adhesive strip.
Also in a particular embodiment, the holding piece incorporates one or more substances promoting healing and/or having an antiseptic effect.
Preferably, these substances are chosen such that they have no direct activity on the conversion of light into heat, which could be detrimental to the desired healing process.
Advantageously, in its zone covering the wound, the holding piece includes at least one region whose absorption coefficient at the wavelength of the laser radiation used is chosen such that the quantity of energy absorbed by said holding piece is not more than 50% of the incident energy, and preferably is less than 20% of said incident energy.
For example, the wavelength of the laser radiation used is chosen from the following values or ranges of values: 800 nm to 980 nm; 1.06 xcexcm to 1.32 xcexcm; 0.514 xcexcm; 2.9 xcexcm; 10.6 xcexcm; and 0.805 xcexcm; and preferably from the following values: 810 nm; 980 nm; 1.55 xcexcm; and 532 nm.
The invention also provides a holding piece as defined above.
The invention also provides a method of closing a wound, said method comprising the following steps:
approximating the lips of the wound, and sticking a holding piece on the tissue across the wound, thereby covering the wound and keeping the lips of said wound approximated; and
uniting the lips of the wound by performing tissue bonding by means of laser radiation through the holding piece, the holding piece being sufficiently transparent at the wavelength of the laser radiation for the energy from said radiation to be sufficient, after it has passed through said region, to perform the desired tissue bonding.
Preferably, the holding piece is left on the wound after the laser radiation treatment for at least two days, and preferably for a period lying in the range two days to seven days.
The invention also provides the use of apparatus as defined above for uniting the lips of a wound during an operation, in particular a cosmetic surgery operation.
The invention also provides a method of cosmetically treating the skin, the method making it possible to reduce the risks of an ugly scar forming during healing of a wound, said method comprising the following steps:
applying a holding piece as defined above against the skin; and
irradiating the skin through said holding piece by means of a laser as defined above.
The invention also provides a holding piece designed to be used in surgical laser treatment by being applied against tissue around the lips of a wound so as to hold them in a predetermined position at least during the exposure to laser radiation.